| NPI | 1801859673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: NC 201401023) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: KY 22337) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2018-05-17 |