NPI | 1073581088 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: VA 101270294) |
Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.086957) |
208000000X Pediatrics (Licence: MD D64655) | |
Enumeration Date | 2006-03-08 |
Last Update Date | 2020-10-25 |