| NPI | 1629137385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A72670) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 77897-20) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2025-10-01 |