| NPI | 1487624391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OR MD18410) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR MD18410) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2023-05-28 |