| NPI | 1548287378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 039893) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 039893) |
| 208000000X Pediatrics (Licence: CT 039893) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2012-01-18 |