| NPI | 1447630595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 22558) |
| Additional Taxonomies | 208D00000X General Practice (Licence: HI DOS-1777) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2022-07-26 |