NPI | 1518079953 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: CA G150703) |
Additional Taxonomies | 282NC2000X General Acute Care Hospital, Children (Licence: WA MD00015956) |
Enumeration Date | 2006-08-31 |
Last Update Date | 2020-07-28 |