| NPI | 1326067034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 10926) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 010926) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2014-03-11 |