| NPI | 1689695876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C55496) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 232883-1) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2013-01-02 |