| NPI | 1750421640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO R6866) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R6866) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2013-05-13 |