| NPI | 1851955892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61331159) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA 61331159) |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2024-08-09 |