| NPI | 1417244625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: WA 60563283) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA 60563283) |
| 208D00000X General Practice (Licence: HI 17046) | |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2019-03-06 |