NPI | 1821649930 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME156771) |
Additional Taxonomies | 208000000X Pediatrics (Licence: TX 694410) |
Enumeration Date | 2019-09-20 |
Last Update Date | 2023-09-19 |