NPI | 1730353558 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: CA 20A11235) |
Additional Taxonomies | 208000000X Pediatrics (Licence: OH 58002205) |
Enumeration Date | 2008-04-14 |
Last Update Date | 2021-11-29 |