| NPI | 1205243763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: CA 129937) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 129937) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2014-07-16 |