| NPI | 1013291103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A117874) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101250361) |
| Enumeration Date | 2011-10-06 |
| Last Update Date | 2018-06-12 |