| NPI | 1366637555 |
|---|---|
| Former Name | MATTHEW ROBERT HANNASCH |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IN 02004768A) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 20A11818) |
| 208000000X Pediatrics (Licence: VA 0102205035) | |
| 208000000X Pediatrics (Licence: OK 4644) | |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2019-08-26 |