| NPI | 1083042824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX PA10497) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX PA10497) |
| Enumeration Date | 2013-10-14 |
| Last Update Date | 2022-07-21 |