| NPI | 1386676351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA md043162E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD043162E) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2018-11-06 |