| NPI | 1184643447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: WA MD00027850) |
| Additional Taxonomies | 2080P0203X Pediatrics Pediatric Critical Care Medicine (Licence: WA 27850) |
| 208000000X Pediatrics (Licence: WA MD00027850) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2021-03-31 |