NPI | 1114018405 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: DE C10003032) |
Additional Taxonomies | 208000000X Pediatrics (Licence: DE C10003032) |
208M00000X Hospitalist (Licence: DE C10003032) | |
2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: DE C10003032) | |
Enumeration Date | 2006-09-28 |
Last Update Date | 2015-09-15 |