| NPI | 1689665093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 43234) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: WI 43234) |
| 208000000X Pediatrics (Licence: WI 43234) | |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2024-10-18 |