| NPI | 1306075395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NM MD2011-0531) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A108100) |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2012-01-26 |