| NPI | 1639210669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301061253) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301061253) |
| Enumeration Date | 2007-02-11 |
| Last Update Date | 2012-03-13 |