| NPI | 1538485289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101019529) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD010749 E) |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2013-03-13 |