| NPI | 1801278478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX T9086) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OK 5960) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2022-09-21 |