| NPI | 1235375486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 17395) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 17395) |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2023-03-07 |