| NPI | 1811945249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 33752) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 33752) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2007-08-15 |