NPI | 1700997103 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: LA 018200) |
Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: LA MD.018200) |
Enumeration Date | 2006-08-31 |
Last Update Date | 2019-03-11 |