| NPI | 1477710176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61330399) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR MD212995) |
| 208000000X Pediatrics (Licence: NH 15936) | |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2025-05-06 |