NPI | 1386058923 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: KY 50458) |
Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL37060) |
Enumeration Date | 2014-06-11 |
Last Update Date | 2021-03-10 |