| NPI | 1558924787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 14164875-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 180517) |
| Enumeration Date | 2019-04-14 |
| Last Update Date | 2024-12-31 |