| NPI | 1558853309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: TX U8066) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.141987) |
| 207RA0000X Internal Medicine, Adolescent Medicine (Licence: NM MD2021-0733) | |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2024-03-21 |