NPI | 1225232721 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101241899) |
Additional Taxonomies | 208000000X Pediatrics (Licence: MA 272928) |
Enumeration Date | 2007-06-11 |
Last Update Date | 2020-11-10 |