| NPI | 1740572437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0079276) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D0079276) |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2015-07-19 |