| NPI | 1194986208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N3945) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX N3945) |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2010-11-30 |