| NPI | 1164651683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: OK 7931) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 7931) |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2009-07-06 |