| NPI | 1316258601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2010019760) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2010019760) |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2017-03-15 |