NPI | 1902461015 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: TX T4268) |
Additional Taxonomies | 208000000X Pediatrics (Licence: TX 10067755) |
Enumeration Date | 2019-05-03 |
Last Update Date | 2022-06-08 |