NPI | 1356308167 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: CA C54033) |
Additional Taxonomies | 208000000X Pediatrics (Licence: UT 5205709-1205) |
Enumeration Date | 2006-04-26 |
Last Update Date | 2012-03-12 |