| NPI | 1740333012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA 07414R) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA 07414r) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2016-12-22 |