| NPI | 1467575266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX U1018) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX U1018) |
| Enumeration Date | 2007-04-08 |
| Last Update Date | 2023-09-29 |