| NPI | 1972703213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2022045451) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A109516) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2022-11-28 |