| NPI | 1639167372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A64907) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A64907) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2018-04-17 |