| NPI | 1831191386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA C191122) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MD D0052534) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: PA MD474870) | |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2024-01-05 |