| NPI | 1316094246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: LA 024975) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: LA 024975) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2007-07-08 |