| NPI | 1356308167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C54033) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 5205709-1205) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2012-03-12 |