| NPI | 1306106380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 270125) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A135188) |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2022-06-06 |