| NPI | 1124482781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61033890) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61033890) |
| 208000000X Pediatrics (Licence: WA ML.60657448) | |
| 208000000X Pediatrics (Licence: MD D0087340) | |
| 208000000X Pediatrics (Licence: DC MD047137) | |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2023-05-01 |