| NPI | 1730249814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 42418) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 42418) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2015-10-14 |