| NPI | 1669425120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00039324) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: MD D64083) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2023-07-03 |