| NPI | 1396905634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA AFE77437) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 057256) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2008-06-10 |