| NPI | 1043400435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 56948) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 56948) |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2018-08-06 |