| NPI | 1922459031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C196057) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NM MD2019-0052) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2024-11-20 |