| NPI | 1164400354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: ID M-13463) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NM 82-210) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2021-05-21 |