| NPI | 1912252743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 131998) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A131998) |
| 208000000X Pediatrics (Licence: MI 4301100957) | |
| 208D00000X General Practice (Licence: CA A131998) | |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2024-06-07 |