| NPI | 1497198865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 55874) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 55874) |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2018-10-03 |