| NPI | 1891154530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD.MD.61691088) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: KY 54784) |
| 208000000X Pediatrics (Licence: WA MD.MD.61691088) | |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2025-06-30 |