| NPI | 1467401042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: CA A042653) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A42653) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2017-12-01 |