| NPI | 1710901541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX J4059) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX J4059) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2021-12-01 |