| NPI | 1790362192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 12970419-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 12970419-1205) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2022-08-08 |