| NPI | 1851481758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G75131) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G75131) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2015-07-16 |