| NPI | 1376648758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101043189) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 72423) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2017-02-23 |