| NPI | 1528463908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G58537) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101256381) |
| Enumeration Date | 2014-10-28 |
| Last Update Date | 2022-03-02 |