| NPI | 1871720136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61148701) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR MD169390) |
| Enumeration Date | 2009-06-14 |
| Last Update Date | 2024-05-21 |