| NPI | 1013949304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A67792) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A67792) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2014-08-21 |