| NPI | 1124128673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M3434) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX M3434) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2022-06-01 |