| NPI | 1780800813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 6959101-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 5052) |
| 208000000X Pediatrics (Licence: NE 5052) | |
| 208000000X Pediatrics (Licence: UT 6959101-1205) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2013-12-19 |