| NPI | 1972604528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: CT 034996) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: FL ME 72340) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2007-07-08 |