| 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 |