NPI | 1992068936 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125.061142) |
Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125.061142) |
Enumeration Date | 2012-06-22 |
Last Update Date | 2012-06-22 |