| NPI | 1487737219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX K0026) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: TX K0026) |
| 207QA0000X Family Medicine, Adolescent Medicine (Licence: TX K0026) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2026-01-08 |