| NPI | 1215967245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ME MD15294) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: ME 015294) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2018-04-18 |