| NPI | 1316339054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: HI 17994) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 131115) |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2016-01-07 |