| NPI | 1245423011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 67665) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D0036014) |
| 208000000X Pediatrics (Licence: CA G37534) | |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2016-01-13 |