| NPI | 1558844217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PR 21866) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 21866) |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2024-08-20 |