| NPI | 1487613840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 33878) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: NC 33878) |
| 208000000X Pediatrics (Licence: NC 33878) | |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: NC 33878) | |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2018-06-14 |