| NPI | 1700032422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D78519) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A98444) |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2025-04-03 |