| NPI | 1013192327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101059077) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101059077) |
| Enumeration Date | 2008-01-04 |
| Last Update Date | 2011-01-06 |