| NPI | 1730296955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR OR MDO6703) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA WA MD00009777) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2007-07-10 |