| NPI | 1881618171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G78012) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD417311) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2016-08-15 |