NPI | 1760483242 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: KY 13868) |
Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME123112) |
Enumeration Date | 2005-08-09 |
Last Update Date | 2020-10-26 |