| NPI | 1285381012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NE 35946) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 35946) |
| Enumeration Date | 2022-03-02 |
| Last Update Date | 2025-08-18 |