| NPI | 1598185217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME138115) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A129412) |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2023-09-26 |