| NPI | 1720008626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301058398) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301058398) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2022-10-24 |