| NPI | 1154356780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M7983) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 33649) |
| 208000000X Pediatrics (Licence: AZ 33649) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2014-08-14 |