| NPI | 1003806431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX K5503) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 38899) |
| 208000000X Pediatrics (Licence: TX K5503) | |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2022-10-17 |