| NPI | 1063667764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20a 10582) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 20a 10582) |
| Enumeration Date | 2008-11-21 |
| Last Update Date | 2011-11-29 |