| NPI | 1700042231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: VA 0101249428) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: OH KOME3968700) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2019-04-26 |