| NPI | 1710965686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 104392) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00044857) |
| Enumeration Date | 2006-01-02 |
| Last Update Date | 2009-07-15 |