NPI | 1104884410 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME133640) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NY 181721) |
Enumeration Date | 2006-05-03 |
Last Update Date | 2021-10-26 |