NPI | 1538253604 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: MA 30827) |
Additional Taxonomies | 171W00000X Contractor (Licence: MA 30827) |
Enumeration Date | 2006-10-03 |
Last Update Date | 2021-03-29 |