| NPI | 1891709820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD00046634) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AK 6473) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2012-06-13 |