| NPI | 1528168432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD00048590) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NV 9069) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2021-06-22 |