| NPI | 1659538197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX N6201) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 67978) |
| 208D00000X General Practice (Licence: TN 55939) | |
| 208D00000X General Practice (Licence: PA MD465526) | |
| 208D00000X General Practice (Licence: TX N6201) | |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2023-10-15 |