| NPI | 1578504692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 20058) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 20058) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2016-06-28 |