| NPI | 1215012885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR OR MD11338) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00034644) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2007-07-08 |