NPI | 1134382625 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: KY 42389) |
Additional Taxonomies | 208000000X Pediatrics (Licence: KY R1440) |
Enumeration Date | 2008-07-07 |
Last Update Date | 2023-08-09 |