| NPI | 1720066061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A61200) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA 33426) |
| 208000000X Pediatrics (Licence: HI 9078) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2025-01-30 |