| NPI | 1619994472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 029264) |
| Additional Taxonomies | 207RA0000X Internal Medicine Adolescent Medicine (Licence: NC 200301312) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2012-01-17 |