| NPI | 1942304324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR OR MD14385) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA WA MD00034526) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2007-07-08 |