| NPI | 1467981175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A193112) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101269906) |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2024-07-24 |