| NPI | 1487819413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME118867) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: AR E-6028) |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2019-01-03 |