| NPI | 1306929252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D98218) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD000040535) |
| 208000000X Pediatrics (Licence: MT 11916) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2023-08-21 |