| NPI | 1992817860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A46203) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A46203) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2025-12-15 |