| NPI | 1649238445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA 60599715) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AR C5975) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2017-05-24 |