| NPI | 1053940965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 12441618-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 12441618-1205) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2021-09-17 |