| NPI | 1750709374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX R7550) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX R7550) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2022-03-23 |