| NPI | 1811195472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N3628) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX N3628) |
| 208000000X Pediatrics (Licence: TX N3628) | |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2021-12-02 |