| NPI | 1861576845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G41278) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 254926) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2013-06-25 |