| NPI | 1134315872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 6353681-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 6353681-1205) |
| Enumeration Date | 2007-09-17 |
| Last Update Date | 2021-10-21 |