| NPI | 1477711737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A108974) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA Not yet issued) |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2022-04-12 |