| NPI | 1194939033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101047343) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101047343) |
| 202K00000X (Licence: VA 0101047343) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2015-10-10 |