| NPI | 1588632798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: CA C5657204) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 216212) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2022-08-17 |