| NPI | 1720068174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX L9939) |
| Additional Taxonomies | 207PP0204X Emergency Medicine Pediatric Emergency Medicine (Licence: TX L9939) |
| 208000000X Pediatrics (Licence: TX L9939) | |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2015-06-18 |