| NPI | 1568532596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101238017) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: NY 232770) |
| 207RA0000X Internal Medicine, Adolescent Medicine (Licence: VA 0101238017) | |
| 207RA0000X Internal Medicine, Adolescent Medicine (Licence: NJ 25MA07786000) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2021-12-23 |