| NPI | 1184657082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA G88450) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: AZ 16648) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2016-10-14 |