| NPI | 1356548002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 048604) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 048604) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: GA 048604) | |
| 2080P0205X Pediatrics, Pediatric Endocrinology (Licence: GA 048604) | |
| 209800000X Legal Medicine (Licence: GA 048604) | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2007-07-08 |