| NPI | 1700877529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: WA MD00048248) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2002-00397) |
| Enumeration Date | 2005-11-01 |
| Last Update Date | 2019-03-27 |