| NPI | 1508048935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q1514) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301090392) |
| 208000000X Pediatrics (Licence: MI 4301090392) | |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2018-09-13 |