| NPI | 1508800756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA A79482) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A79482) |
| 207R00000X Internal Medicine (Licence: FL ME147702) | |
| 207RA0000X Internal Medicine, Adolescent Medicine (Licence: CA A79482) | |
| 208000000X Pediatrics (Licence: FL ME147702) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2023-03-08 |