| NPI | 1578588976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 101052275) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101052275) |
| 208000000X Pediatrics (Licence: VA 101052275) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2011-07-14 |