| NPI | 1649227158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI MD10216) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: HI MD10216) |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2013-06-11 |