NPI | 1649539818 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: SC 82077) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2017-02273) |
Enumeration Date | 2012-05-09 |
Last Update Date | 2021-05-07 |