| NPI | 1629062203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN MD014213) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 14213) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2015-01-20 |