| NPI | 1063456218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ND 9202) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: ND 9202) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2014-03-17 |