| NPI | 1306852934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C141296) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301076933) |
| 208000000X Pediatrics (Licence: IN 01071369A) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2022-05-24 |