| NPI | 1114185493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA OP60093316) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA OT-011450) |
| Enumeration Date | 2008-05-23 |
| Last Update Date | 2015-05-28 |