| NPI | 1447241963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD016341E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD016341E) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2011-02-14 |