| NPI | 1154347169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G54868) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G54868) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2020-02-29 |