| NPI | 1578699443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PR 08340) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN412) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2025-11-06 |