| NPI | 1114909082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI 4014) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MA 57676) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2021-10-07 |