| NPI | 1982686846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 63265) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: MA 152291) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2025-12-22 |