| NPI | 1215198734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2012-00728) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2012-00728) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2021-05-06 |