| NPI | 1942390810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD00035182) |
| Additional Taxonomies | 2080A0000X Pediatrics Adolescent Medicine (Licence: WA MD00035172) |
| 207R00000X Internal Medicine (Licence: WA MD00035182) | |
| 2080C0008X Pediatrics Child Abuse Pediatrics (Licence: WA MD00035182) | |
| 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: WA MD00035182) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2019-12-04 |