| NPI | 1982938700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ID M-12467) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD 60174015) |
| Enumeration Date | 2009-09-25 |
| Last Update Date | 2016-03-28 |