| NPI | 1962507574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A049289) |
| Additional Taxonomies | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: CA A049289) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2013-07-05 |