| NPI | 1275614539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 60-273120) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00025625) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2013-12-23 |