| NPI | 1043210271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA L013924) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA L013924) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA L013924) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2019-05-10 |