| NPI | 1326049263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 20A3180) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA B58230) |
| 207Q00000X Family Medicine (Licence: CA 20A3180) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2015-10-29 |