| NPI | 1124379607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OK 29042) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-40163) |
| Enumeration Date | 2012-09-25 |
| Last Update Date | 2023-01-25 |