NPI | 1306322292 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: CO DR0074979) |
Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD484101) |
Enumeration Date | 2018-07-14 |
Last Update Date | 2025-06-10 |