| NPI | 1548372600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2009-00462) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA ML20008679) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2009-08-18 |