| NPI | 1760418883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 34015) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 34015) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2011-06-22 |