| NPI | 1669580098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD00035879) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR MD20968) |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2007-07-08 |