| NPI | 1770696403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD00034593) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR MD20631) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2022-02-04 |