| NPI | 1770871642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2023039054) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2023039054) |
| Enumeration Date | 2011-07-13 |
| Last Update Date | 2023-11-28 |