| NPI | 1255308896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA GFE 068252) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 31640-020) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2011-10-26 |