| NPI | 1568924231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A208292) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA 61339518) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2026-07-14 |