| NPI | 1164412995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: WA MD60609633) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD60609633) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: HI MD-9970) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2022-11-15 |