| NPI | 1821409939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX w1728) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A126806) |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2025-12-08 |