| NPI | 1184761462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO DR.0051611) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD 60079939) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2021-03-17 |