| NPI | 1609372515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A175868) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 89501) |
| Enumeration Date | 2018-04-01 |
| Last Update Date | 2022-01-12 |