| NPI | 1073574554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 027700) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G50918) |
| Enumeration Date | 2006-04-01 |
| Last Update Date | 2016-03-17 |