NPI | 1881785137 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CT 66626) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NH 11630) |
2080A0000X Pediatrics, Adolescent Medicine (Licence: MA 269024) | |
2080A0000X Pediatrics, Adolescent Medicine (Licence: ME MD17852) | |
Enumeration Date | 2006-09-28 |
Last Update Date | 2020-12-28 |