| NPI | 1346413424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A109098) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301084305) |
| 208000000X Pediatrics (Licence: MI 4301084305) | |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2018-03-17 |