| NPI | 1154350692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 22051) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 22051) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2013-04-30 |