| NPI | 1548248065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A44724) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NM 96-256) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2022-11-16 |