| NPI | 1275582439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine (Licence: TX E2505) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX E2505) |
| 207RA0000X Internal Medicine, Adolescent Medicine (Licence: TX E2505) | |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: TX E2505) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2009-07-01 |