| NPI | 1376962936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DE C1-0012077) |
| Additional Taxonomies | 208D00000X General Practice (Licence: DE C1-0012077) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2025-01-03 |