| NPI | 1457618084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2017-01811) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2018-01811) |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2018-03-17 |