| NPI | 1083936520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2011-00764) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A110864) |
| Enumeration Date | 2010-02-25 |
| Last Update Date | 2014-07-01 |