NPI | 1710901541 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: TX J4059) |
Additional Taxonomies | 208D00000X General Practice (Licence: TX J4059) |
Enumeration Date | 2006-07-26 |
Last Update Date | 2021-12-01 |