| NPI | 1528061488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX J6623) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX J6623) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2025-12-03 |