| NPI | 1639221088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine (Licence: WA MD00036504) |
| Additional Taxonomies | 2080P0208X Pediatrics Pediatric Infectious Diseases (Licence: WA MD00036504) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2007-07-27 |