| NPI | 1861496671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD.14448R) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 14448R) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2019-01-14 |