| NPI | 1902251440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 110842) |
| Additional Taxonomies | 207QB0002X Family Medicine, Bariatric Medicine (Licence: MN 72538) |
| 2080B0002X Pediatrics, Obesity Medicine (Licence: GA 110842) | |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2026-04-22 |