| NPI | 1346345493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G27766) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: HI 9606) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2018-11-27 |