| NPI | 1295874022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA A87551) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A87551) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2017-04-13 |