| NPI | 1407233596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61684425) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A176817) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2025-07-17 |