| NPI | 1083600274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 7585) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 7583) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2015-02-24 |