| NPI | 1417576885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DE C1-0027407) |
| Additional Taxonomies | 208D00000X General Practice (Licence: DE C1-0027407) |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2026-02-11 |