NPI | 1780672717 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: NY 185997) |
Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME68149) |
Enumeration Date | 2005-10-13 |
Last Update Date | 2012-12-14 |