| NPI | 1821064866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60056481) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 200501488) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2013-02-14 |