| NPI | 1336274182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A115826) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 19509) |
| 208000000X Pediatrics (Licence: MP 478) | |
| 208000000X Pediatrics (Licence: MN 51436) | |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2012-05-02 |