| NPI | 1700982857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: MA 245547) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: CO 44735) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2013-08-20 |