| NPI | 1790289320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A173920) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA ML60864362) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2021-07-27 |