| NPI | 1952478232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX J0700) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX J0700) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2022-12-10 |