NPI | 1003228396 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: WA OP-60628273) |
Additional Taxonomies | 208D00000X General Practice (Licence: WA OP 60628273) |
Enumeration Date | 2014-05-21 |
Last Update Date | 2023-08-21 |