| NPI | 1548444250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A110593) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NV 13978) |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2023-03-07 |