| NPI | 1639267610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN MD8747) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA C146048) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2023-03-15 |