| NPI | 1063263580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NV 0126) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NV 0126) |
| Enumeration Date | 2024-04-01 |
| Last Update Date | 2024-04-03 |