| NPI | 1821482886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX Q8590) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX Q8590) |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2024-01-17 |