| NPI | 1164539508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX L0192) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX L0192) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2022-05-12 |