| NPI | 1063649705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD 60212424) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A107763) |
| Enumeration Date | 2009-06-21 |
| Last Update Date | 2022-11-22 |