| NPI | 1275853368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD.206538) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA MD.206538) |
| 207R00000X Internal Medicine (Licence: CA A115191) | |
| 208000000X Pediatrics (Licence: CA A115191) | |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2015-03-05 |