| NPI | 1699902114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO DR.0055351) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A121944) |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2015-07-17 |