| NPI | 1659594448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 55519) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G47881) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2007-07-08 |