| NPI | 1508896952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 962) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 962) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2017-11-20 |