| NPI | 1194854836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX F0226) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA C038721) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA C038721) | |
| 208D00000X General Practice (Licence: CA C038721) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2018-11-27 |