| NPI | 1306047881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD29062) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD60094937) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2019-12-05 |