| NPI | 1871557579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 8790) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 8790) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2024-11-12 |