| NPI | 1740426352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A23496CA) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A23496) |
| Enumeration Date | 2009-01-02 |
| Last Update Date | 2009-01-02 |