| NPI | 1578501672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: ND 11312) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: IL 036-111489) |
| 207RA0000X Internal Medicine, Adolescent Medicine (Licence: MT 112716) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2022-11-23 |