| NPI | 1225133556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G77588) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00045952) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2020-03-11 |