| NPI | 1568551752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine (Licence: CA G18111) |
| Additional Taxonomies | 2080P0205X Pediatrics Pediatric Endocrinology (Licence: CA G18111) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-07-09 |