NPI | 1659366292 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: CA A53984) |
Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA A53984) |
Enumeration Date | 2005-09-20 |
Last Update Date | 2022-10-21 |