| NPI | 1992772529 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C139250) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MD D0058576) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2023-03-07 |