| NPI | 1083636930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 35511) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: IN 01043333) |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2016-10-26 |