NPI | 1740333012 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: LA 07414R) |
Additional Taxonomies | 208D00000X General Practice (Licence: LA 07414r) |
Enumeration Date | 2007-01-19 |
Last Update Date | 2016-12-22 |