| NPI | 1255428975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A35789) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A35789) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: CA A35789) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2011-12-07 |