| NPI | 1891133658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C187009) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL me128704) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2023-07-28 |