| NPI | 1831304906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD00030788) |
| Additional Taxonomies | 2080A0000X Pediatrics Adolescent Medicine (Licence: AZ 36151) |
| 207PP0204X Emergency Medicine Pediatric Emergency Medicine (Licence: WA MD00030788) | |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2014-02-05 |