| 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 |