| NPI | 1013991439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 25897) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: NC 25897) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2014-03-25 |