NPI | 1376685685 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: CA A88903) |
Additional Taxonomies | 208000000X Pediatrics (Licence: CA A88903) |
Enumeration Date | 2007-02-13 |
Last Update Date | 2016-04-20 |