| NPI | 1780719872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G393080) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G393080) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2012-01-31 |