| NPI | 1730322405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 8273584-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD60929411) |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2019-07-22 |