| NPI | 1912394735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 10117282-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 157281) |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2025-01-15 |