| NPI | 1134174105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX J7056) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: TX J7056) |
| 208D00000X General Practice (Licence: TX J7056) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2014-12-01 |