NPI | 1578567970 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: NE 17310) |
Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-30522) |
Enumeration Date | 2005-06-13 |
Last Update Date | 2022-07-29 |