| NPI | 1932217353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 17516) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 17516) |
| Enumeration Date | 2006-08-26 |
| Last Update Date | 2023-03-07 |