| NPI | 1326492356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A151507) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KS 04-43105) |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2021-02-10 |