| NPI | 1477662294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD00023688) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: WA MD00023688) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2007-07-08 |