| NPI | 1073678553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 32657) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A78630) |
| 208000000X Pediatrics (Licence: WA ML20006245) | |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2011-07-19 |