| NPI | 1205864154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NE 15996) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 15996) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2023-09-26 |