| NPI | 1043310865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD00029893) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: ID M17055) |
| 208D00000X General Practice (Licence: ID M17055) | |
| 208D00000X General Practice (Licence: WA MD00029893) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2023-03-10 |