| NPI | 1053304816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101010791) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: MI 5101010791) |
| 208000000X Pediatrics (Licence: MI 5101010791) | |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2021-04-16 |