| NPI | 1467543918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A35088) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A35088) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: CA A35088) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA A35088) | |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: CA A35088) | |
| 207QA0000X Family Medicine, Adolescent Medicine (Licence: CA A35088) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2010-10-29 |