| NPI | 1982792065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C51079) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME53118) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2026-07-06 |