NPI | 1962518191 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: TX H5589) |
Additional Taxonomies | 174400000X Specialist (Licence: TX H5589) |
Enumeration Date | 2006-08-21 |
Last Update Date | 2015-12-22 |