| NPI | 1952356743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA G30253) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G30253) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2022-06-09 |