| NPI | 1104994268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A86101) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A86101) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2014-01-28 |