| NPI | 1962579649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD438712) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G84208) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2010-01-22 |