NPI | 1376561985 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ME58227) |
Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME58227) |
Enumeration Date | 2006-07-18 |
Last Update Date | 2012-12-07 |