| NPI | 1487404604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 14248063-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 14248063-1205) |
| Enumeration Date | 2024-03-22 |
| Last Update Date | 2025-11-14 |