| NPI | 1528147618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 8654) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NH 8654) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2024-01-11 |