| NPI | 1275539660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60217406) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 200100885) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2013-03-07 |