| NPI | 1134141096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AL 00022416) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 00022416) |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2011-03-30 |