| NPI | 1952509390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101247001) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: VA 0101247001) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2024-03-21 |