| NPI | 1427060987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD00024096) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00024096) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2019-04-09 |