| NPI | 1326054776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A045813) |
| Additional Taxonomies | 2080A0000X Pediatrics Adolescent Medicine (Licence: CA A45813) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2016-04-06 |