| NPI | 1154825313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 11415673-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 11415673-1205) |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2019-09-13 |