| NPI | 1265744718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ R71994) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A123121) |
| Enumeration Date | 2010-07-12 |
| Last Update Date | 2013-08-22 |