| NPI | 1376673376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO 49888) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A93970) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2013-07-12 |