NPI | 1699760629 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: UT 10534932-1205) |
Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD417392) |
Enumeration Date | 2005-09-15 |
Last Update Date | 2022-08-31 |