| NPI | 1548335854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 051268) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD61412970) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2023-06-16 |