| NPI | 1356453708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: WA MD00045058) |
| Additional Taxonomies | 282NC2000X General Acute Care Hospital, Children (Licence: WA MD00045058) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2016-03-28 |