NPI | 1750425385 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: CO 24348) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 24348) |
208D00000X General Practice (Licence: CO 24348) | |
Enumeration Date | 2007-02-16 |
Last Update Date | 2016-06-07 |