| NPI | 1689092264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61121460) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR MD182163) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2024-06-13 |