| NPI | 1639136203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PR 8596) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 8596) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2007-07-09 |