| NPI | 1578651089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101270925) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 21275) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2024-11-08 |