| NPI | 1679928618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ME MD23688) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: ME MD23688) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: ME MD23688) | |
| 208000000X Pediatrics (Licence: ME MD23688) | |
| Enumeration Date | 2016-04-27 |
| Last Update Date | 2026-03-11 |