| NPI | 1235137647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NV 7336) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA C31623) |
| 208000000X Pediatrics (Licence: NM 73-177) | |
| Enumeration Date | 2005-07-09 |
| Last Update Date | 2007-07-08 |