| NPI | 1043214661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA GO51871) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: CA G051871) |
| 208000000X Pediatrics (Licence: CA GO51871) | |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2018-06-26 |