| NPI | 1487991139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA GFE6169) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA GFE6169) |
| Enumeration Date | 2013-01-14 |
| Last Update Date | 2013-01-14 |