| NPI | 1346308244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 79042) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: FL ME37619) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2022-08-29 |