| NPI | 1104814615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME40147) |
| Additional Taxonomies | 207RA0000X Internal Medicine Adolescent Medicine (Licence: FL ME40147) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2019-11-22 |