| NPI | 1346255221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 7977) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: AZ 7977) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: AZ 7977) | |
| 208000000X Pediatrics (Licence: AZ 7977) | |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2011-05-18 |