NPI | 1588720916 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: CA A53378) |
Additional Taxonomies | 208D00000X General Practice (Licence: CA A53378) |
Enumeration Date | 2006-12-29 |
Last Update Date | 2009-07-23 |