| NPI | 1114960663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M5037) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: IL 036104962) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2018-12-28 |