| NPI | 1063610723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G87911) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 155364-1205) |
| Enumeration Date | 2007-07-04 |
| Last Update Date | 2007-07-08 |