| NPI | 1316072788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WY 7923A) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A91742) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2008-08-11 |