NPI | 1346201951 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD455129) |
Additional Taxonomies | 208000000X Pediatrics (Licence: MN 40379) |
Enumeration Date | 2006-03-31 |
Last Update Date | 2016-06-09 |