| NPI | 1407020415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 254407) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 050646) |
| 208000000X Pediatrics (Licence: CT 050646) | |
| 208000000X Pediatrics (Licence: MA 254407) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: MA 254407) | |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2022-02-02 |