NPI | 1043673270 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MD D0099006) |
Additional Taxonomies | 208000000X Pediatrics (Licence: MD D0099006) |
2083A0300X Preventive Medicine, Addiction Medicine (Licence: MD D0099006) | |
Enumeration Date | 2016-04-04 |
Last Update Date | 2024-06-20 |