| NPI | 1477535169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 167151-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G89247) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2025-09-15 |