| NPI | 1730392143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60020295) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A98423) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2012-09-21 |