| NPI | 1821019449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A34839) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A34839) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2013-01-30 |