| NPI | 1225129604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DE C1-0003927) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DE C10003927) |
| 208D00000X General Practice (Licence: DE C10003927) | |
| 208D00000X General Practice (Licence: DE C1-0003927) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2017-11-09 |