| NPI | 1477013357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A182215) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA PTL1446) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2023-01-24 |