| NPI | 1912272105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A136811) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA ML60292840) |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2021-12-06 |