| NPI | 1588772453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C201813) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 23918) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2025-05-20 |