| NPI | 1801081948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60105626) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60105626) |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2013-09-16 |