| NPI | 1548795107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD481292) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A159633) |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2023-11-28 |