| NPI | 1386811073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102203103) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102203103) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: VA 0102203103) | |
| 208000000X Pediatrics (Licence: VA 0102203103) | |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2023-06-09 |