| NPI | 1467745331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60576068) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA ML 60292225) |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2015-09-08 |