NPI | 1336146406 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME54994) |
Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME54994) |
Enumeration Date | 2005-07-05 |
Last Update Date | 2018-09-19 |