| NPI | 1811130206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P6020) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX P6020) |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2020-12-01 |