| NPI | 1164483483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9501254) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 9501254) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2012-02-22 |