| NPI | 1639268584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301043586) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: MI 4301043586) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2012-03-27 |