| NPI | 1124284625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 43045) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: AZ 43045) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2023-05-08 |