| NPI | 1356445522 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C152422) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301062743) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2025-02-20 |