| NPI | 1205078896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080H0002X (Licence: WA MD60274486) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD 60274486) |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2013-06-26 |