NPI | 1275791253 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: LA 204482) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NY 253214) |
Enumeration Date | 2008-05-27 |
Last Update Date | 2012-09-24 |