| NPI | 1316915846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K0717) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX K0717) |
| 208000000X Pediatrics (Licence: TX K0717) | |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2017-06-16 |