| NPI | 1063441137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301060845) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301060845) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2022-04-11 |