| NPI | 1841793940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NE 32085) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 32085) |
| Enumeration Date | 2018-03-14 |
| Last Update Date | 2024-05-21 |