| NPI | 1609961838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD09236) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00015567) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-07-08 |