NPI | 1194851063 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA C146978) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NC 25492) |
208000000X Pediatrics (Licence: DC MD034443) | |
2080A0000X Pediatrics, Adolescent Medicine (Licence: NY 180846) | |
2080A0000X Pediatrics, Adolescent Medicine (Licence: MD D0059017) | |
Enumeration Date | 2007-02-26 |
Last Update Date | 2018-06-21 |