| NPI | 1386712578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0201X Internal Medicine, Allergy & Immunology (Licence: MI 4301071426) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301071426) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2010-01-27 |