| NPI | 1386825024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 7637496-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 7637496-1205) |
| 2080S0010X Pediatrics Sports Medicine (Licence: UT 7637496-1205) | |
| Enumeration Date | 2007-11-23 |
| Last Update Date | 2024-04-18 |