| NPI | 1669676219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: DE C10009440) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DE C7-0003828) |
| 208000000X Pediatrics (Licence: PA MT190804) | |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2011-10-11 |