| NPI | 1700042371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60511475) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D0071995) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2015-05-22 |