| NPI | 1700306925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX T1597) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 8047) |
| 207R00000X Internal Medicine (Licence: TX T1597) | |
| 208000000X Pediatrics (Licence: NE 8047) | |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2024-05-22 |