NPI | 1134421118 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: NY 236235) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA07716700) |
Enumeration Date | 2010-11-24 |
Last Update Date | 2020-08-07 |