| NPI | 1750351888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MO R6A65) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO R6A65) |
| 208D00000X General Practice (Licence: KS 76-00002) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2025-05-20 |