| NPI | 1619172731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 29947) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01071330A) |
| 207R00000X Internal Medicine (Licence: SC 29947) | |
| 208000000X Pediatrics (Licence: IN 01071330A) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2012-07-11 |