| NPI | 1801802392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR md26839) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR md26839) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2010-09-29 |