| NPI | 1487093969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A52876) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: CA A52876) |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2026-04-30 |