| NPI | 1780970392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NM 2021-0977) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A130407) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2023-10-19 |