| NPI | 1962426999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60279954) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A94474) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: WA MD60279954) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2013-01-08 |