| NPI | 1548621568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: CA 20A20048) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 20A20048) |
| Enumeration Date | 2016-03-18 |
| Last Update Date | 2026-08-11 |