| NPI | 1184109209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MO 2018025505) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2018025505) |
| 208000000X Pediatrics (Licence: MO 2018025505) | |
| Enumeration Date | 2018-09-25 |
| Last Update Date | 2021-08-21 |