| NPI | 1710949425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD00019737) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA md0019737) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2021-06-22 |