| NPI | 1053468991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD00016347) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA MD00016347) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2014-05-19 |