NPI | 1841285830 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME64041) |
Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site (Licence: FL 5719274) |
Enumeration Date | 2005-09-15 |
Last Update Date | 2014-06-17 |