| NPI | 1346313475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: NC 25605) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NC 25065) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2023-01-06 |