| NPI | 1992182885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080H0002X (Licence: WA OP61077765) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 20A15144) |
| 208000000X Pediatrics (Licence: WA op61077765) | |
| 2080H0002X (Licence: CA 20A15144) | |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2020-08-24 |