| NPI | 1497021083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P9931) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10042715) |
| 208000000X Pediatrics (Licence: TX BP10042715) | |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2016-11-01 |