NPI | 1457346124 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: VT 042-0006288) |
Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: VT 0420006288) |
208000000X Pediatrics (Licence: VT 042-0006288) | |
Enumeration Date | 2005-09-19 |
Last Update Date | 2011-06-02 |