| NPI | 1033405501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q4948) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA L-247760) |
| 208000000X Pediatrics (Licence: TX Q4948) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2016-04-26 |