| NPI | 1972999654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RB0002X Internal Medicine, Bariatric Medicine (Licence: MA 283895) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35135657) |
| 208000000X Pediatrics (Licence: OH 35.135657) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2080B0002X Pediatrics, Obesity Medicine (Licence: MA 283895) | |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2026-08-12 |