| NPI | 1356046643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 205866) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4351050670) |
| 208000000X Pediatrics (Licence: MI 5315239730) | |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2026-06-05 |