NPI | 1063498533 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: AL 23115) |
Additional Taxonomies | 208000000X Pediatrics (Licence: AL 00023115) |
Enumeration Date | 2005-12-16 |
Last Update Date | 2018-03-26 |