NPI | 1760683585 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NE 24022) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NE 24022) |
2080A0000X Pediatrics, Adolescent Medicine (Licence: SD SD9881) | |
Enumeration Date | 2007-05-30 |
Last Update Date | 2023-11-28 |