| NPI | 1497857999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 33868) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G33868) |
| Enumeration Date | 2006-09-04 |
| Last Update Date | 2021-05-19 |