| NPI | 1336179985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME95472) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 15857) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2015-08-24 |