| NPI | 1538622154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA IMLC.MD.61605829) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A195028) |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2024-08-30 |