| NPI | 1811948540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A75961) |
| Additional Taxonomies | 207RA0000X Internal Medicine Adolescent Medicine (Licence: CA A75961) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2013-01-29 |