| NPI | 1154616787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R9718) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX R9718) |
| Enumeration Date | 2011-06-11 |
| Last Update Date | 2021-09-30 |