NPI | 1164403929 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: CA C51781) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NY 216995-1) |
Enumeration Date | 2005-11-09 |
Last Update Date | 2021-08-30 |