| NPI | 1659361137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: TX k7276) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: TX k7276) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2015-10-08 |