| NPI | 1841288859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 30575) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A192389) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2025-09-24 |