| NPI | 1710046636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN MD19294) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN MD19294) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2013-12-18 |