NPI | 1104183904 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: CA A127321) |
Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35144830) |
Enumeration Date | 2012-04-18 |
Last Update Date | 2024-09-11 |