NPI | 1750351888 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: MO R6A65) |
Additional Taxonomies | 208000000X Pediatrics (Licence: MO R6A65) |
Enumeration Date | 2006-01-23 |
Last Update Date | 2022-12-05 |