| NPI | 1518461300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61251044) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A164071) |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2026-05-06 |