| NPI | 1225017353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G77176) |
| Additional Taxonomies | 2080A0000X Pediatrics Adolescent Medicine (Licence: CA G77176) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2014-08-22 |