| NPI | 1750792982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A147624) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD60919488) |
| Enumeration Date | 2014-05-09 |
| Last Update Date | 2022-07-22 |