| NPI | 1811379720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NV 20523) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A154601) |
| Enumeration Date | 2015-06-27 |
| Last Update Date | 2023-10-19 |