NPI | 1679689798 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME97632) |
Additional Taxonomies | 208000000X Pediatrics (Licence: PR 16316) |
Enumeration Date | 2006-08-22 |
Last Update Date | 2012-02-14 |