| NPI | 1801214838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NE 28754) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 28754) |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2023-07-10 |