| NPI | 1679738355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R6364) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301091545) |
| 207R00000X Internal Medicine (Licence: MN 55039) | |
| 208000000X Pediatrics (Licence: MN 55039) | |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2022-05-05 |