| NPI | 1811429012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U6443) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 171226) |
| 208000000X Pediatrics (Licence: TX U6443) | |
| 207R00000X Internal Medicine (Licence: CA 171226) | |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2023-11-01 |