| NPI | 1164456687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60362872) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: ID M-8558) |
| 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: WA MD60362872) | |
| 2080P0207X Pediatrics Pediatric Hematology-Oncology (Licence: ID M-8558) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2019-03-01 |