| NPI | 1538381058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 12914) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 946156) |
| 208000000X Pediatrics (Licence: NV 12914) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2015-07-10 |