| NPI | 1790721678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 026289) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 026289) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2013-09-18 |