| NPI | 1801530076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 86008-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 86008-20) |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2025-08-29 |