NPI | 1215019641 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: CA A46669) |
Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: NJ 25MA05800100) |
208D00000X General Practice (Licence: NV 14165) | |
Enumeration Date | 2006-10-19 |
Last Update Date | 2017-10-10 |