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 |