NPI | 1245617406 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61301644) |
Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-42074) |
Enumeration Date | 2015-04-27 |
Last Update Date | 2022-09-16 |