| NPI | 1730193897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NH 8886) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NH 8886) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2021-06-08 |