| NPI | 1558467050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MT 103375) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MT 103375) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2022-03-11 |