| NPI | 1053525014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61637642) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AR E-7083) |
| 207Q00000X Family Medicine (Licence: WA MD61637642) | |
| 207R00000X Internal Medicine (Licence: TX Q9338) | |
| 207R00000X Internal Medicine (Licence: AR E-7083) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2024-12-20 |