| NPI | 1366489536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: CT 0471821) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI 11245) |
| 208000000X Pediatrics (Licence: CT 0471821) | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2007-12-06 |