| NPI | 1053468249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R9450) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 215148) |
| 208000000X Pediatrics (Licence: NY 215148) | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2023-09-12 |