| NPI | 1306097555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD150386) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G41486) |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2011-09-26 |