| NPI | 1235765181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX S9958) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME138423) |
| Enumeration Date | 2020-03-22 |
| Last Update Date | 2022-08-04 |