NPI | 1831465830 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 055204) |
Additional Taxonomies | 208000000X Pediatrics (Licence: CT 055204) |
Enumeration Date | 2012-03-24 |
Last Update Date | 2016-12-03 |