| NPI | 1710204938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q0513) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX Q0513) |
| Enumeration Date | 2010-04-28 |
| Last Update Date | 2015-12-22 |