NPI | 1073547642 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: PR 6285) |
Additional Taxonomies | 174400000X Specialist (Licence: PR 6285) |
Enumeration Date | 2006-07-10 |
Last Update Date | 2015-06-02 |