| NPI | 1912053349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY 13288C) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: NV 8584) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2021-03-04 |