| NPI | 1255458121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G42555) |
| Additional Taxonomies | 207RA0000X Internal Medicine Adolescent Medicine (Licence: CA G42555) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2007-07-08 |