| NPI | 1497056154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A114487) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A114487) |
| 207R00000X Internal Medicine (Licence: CA A114487) | |
| Enumeration Date | 2010-11-11 |
| Last Update Date | 2019-11-27 |