| NPI | 1861440935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS0006254) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: FL OS0006254) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2014-05-22 |