| NPI | 1861130650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NE 2838) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 2838) |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2025-06-18 |