NPI | 1720117518 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208VP0000X (Licence: DC MD21027) |
Additional Taxonomies | 207L00000X Anesthesiology (Licence: DC MD21027) |
208000000X Pediatrics (Licence: DC MD21027) | |
208D00000X General Practice (Licence: DC MD21027) | |
Enumeration Date | 2007-03-05 |
Last Update Date | 2025-09-11 |