| NPI | 1417247677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 9247403-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 9247403-1205) |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2026-04-13 |