NPI | 1285658898 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: DE C10000547) |
Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD010305E) |
208D00000X General Practice (Licence: DE C10000547) | |
Enumeration Date | 2006-07-27 |
Last Update Date | 2011-12-27 |