| NPI | 1316944093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX J1107) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX J1107) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2022-05-20 |