| NPI | 1174591200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME61125) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL ME61125) |
| 207QA0000X Family Medicine, Adolescent Medicine (Licence: FL ME61125) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2022-08-04 |