NPI | 1336408723 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: MA 273768) |
Additional Taxonomies | 208000000X Pediatrics (Licence: RI MD16109) |
208000000X Pediatrics (Licence: NH 18714) | |
Enumeration Date | 2012-05-07 |
Last Update Date | 2023-02-22 |