| NPI | 1205860806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VI VI1322) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME94422) |
| 208000000X Pediatrics (Licence: VI VI1322) | |
| 208000000X Pediatrics (Licence: FL ME94422) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2011-09-02 |