| NPI | 1477533867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NV 5189) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00042163) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2013-09-27 |