| NPI | 1114939022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A35119) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A35119) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2016-04-16 |