| NPI | 1639156037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NV 8056) |
| Additional Taxonomies | 208D00000X General Practice (Licence: HI MD 6815) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2018-03-17 |