| NPI | 1578677100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME44947) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL 0044947) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2017-08-23 |