NPI | 1073505764 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 174400000X Specialist (Licence: CA A65312) |
Additional Taxonomies | 208000000X Pediatrics (Licence: CA A065312) |
Enumeration Date | 2005-08-18 |
Last Update Date | 2014-12-17 |