| NPI | 1003901893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL me15590) |
| Additional Taxonomies | 174400000X Specialist |
| 208000000X Pediatrics (Licence: FL me15590) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2021-09-03 |