| NPI | 1235321621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A102423) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA MD.200931) |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2011-02-01 |