| NPI | 1073505764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A65312) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A065312) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2014-12-17 |