| NPI | 1538208038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX H3561) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX H3561) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2023-06-27 |