| NPI | 1578750485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD151000) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A100961) |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2010-07-13 |