NPI | 1699752295 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD00027394) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A49982) |
Enumeration Date | 2005-12-27 |
Last Update Date | 2015-12-08 |