| NPI | 1124097043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A102374) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NV 10540) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2012-11-28 |