| NPI | 1922067081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 00A422712) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 00A422712) |
| Enumeration Date | 2006-03-18 |
| Last Update Date | 2012-07-16 |