| NPI | 1811977663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 040077) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 040077) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2020-12-01 |