| NPI | 1528021474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AL 22718) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AL 22718) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2010-02-23 |