| NPI | 1457711707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101263205) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101263205) |
| Enumeration Date | 2016-02-29 |
| Last Update Date | 2020-08-27 |