| NPI | 1093784696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 023871) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 023871) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2014-02-20 |