| NPI | 1477849602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2011019428) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2011019428) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2012-07-13 |