| NPI | 1285762021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: HI 13045) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD186103) |
| 207Q00000X Family Medicine (Licence: CA G45261) | |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2024-09-17 |