| NPI | 1548368731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60205612) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A55019) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2011-03-11 |