NPI | 1730435280 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: CA C50892) |
Additional Taxonomies | 208D00000X General Practice (Licence: CA C50892) |
Enumeration Date | 2012-08-01 |
Last Update Date | 2012-08-01 |