NPI | 1639167372 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: CA A64907) |
Additional Taxonomies | 208D00000X General Practice (Licence: CA A64907) |
Enumeration Date | 2005-10-06 |
Last Update Date | 2018-04-17 |