| NPI | 1336220201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A114759) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A114759) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2012-09-04 |