| NPI | 1043256738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine (Licence: CA A68214) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A68214) |
| 2080A0000X Pediatrics Adolescent Medicine (Licence: WA MD60048703) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2020-05-06 |