| NPI | 1942748413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A146425) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 146425) |
| Enumeration Date | 2017-02-06 |
| Last Update Date | 2022-10-31 |