NPI | 1639121072 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: TX N5454) |
Additional Taxonomies | 208000000X Pediatrics (Licence: GA 040270) |
Enumeration Date | 2006-05-16 |
Last Update Date | 2017-10-12 |