| NPI | 1487738191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G88644) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00026298) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2010-03-29 |