| NPI | 1114936614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine (Licence: TX E1307) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: TX E1307) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2007-07-08 |