| NPI | 1598703977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 16279) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 16279) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2009-08-07 |