| NPI | 1972762805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A97744) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00049419) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2013-01-09 |