| NPI | 1033643481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NE 1862) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 1862) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2021-07-30 |