| NPI | 1699752295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD00027394) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A49982) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2015-12-08 |