| NPI | 1013990563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 16640) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 16640) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2019-05-15 |