NPI | 1326573445 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME170700) |
Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.139870) |
Enumeration Date | 2017-04-26 |
Last Update Date | 2024-11-08 |