| NPI | 1245385236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA 27531) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WA MD00027531) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2016-01-04 |