| NPI | 1346656667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OK 32818) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA unlicensed) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2023-05-24 |