| NPI | 1225476914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 275375) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 275375) |
| 207RA0000X Internal Medicine, Adolescent Medicine (Licence: MA 255941) | |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: MA 275375) | |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2025-09-03 |