| NPI | 1760685234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2007-0650) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VI 1391) |
| 208000000X Pediatrics (Licence: NM MD2007-0650) | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2018-11-20 |