| NPI | 1457989642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2021019731) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2019027169) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2021-06-25 |