| NPI | 1982647939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A-49571) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A-49571) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2011-11-12 |