| NPI | 1407482490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A186177) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA PTL3011) |
| Enumeration Date | 2020-03-21 |
| Last Update Date | 2023-07-21 |