NPI | 1407285307 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 33094) |
Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: AZ 33094) |
208D00000X General Practice (Licence: AZ 33094) | |
Enumeration Date | 2013-11-01 |
Last Update Date | 2013-11-01 |