| NPI | 1144617192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S1140) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 60299) |
| 207R00000X Internal Medicine (Licence: TN 60299) | |
| 208000000X Pediatrics (Licence: TX S1140) | |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2024-05-22 |