| NPI | 1598928244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA ML60019739) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD 60217230) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2021-04-13 |