| 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 |