| NPI | 1194067504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60648254) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA ML60369021) |
| Enumeration Date | 2013-03-24 |
| Last Update Date | 2018-09-14 |