| NPI | 1821067778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N 1075) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 19872) |
| 208000000X Pediatrics (Licence: TX N 1075) | |
| 208000000X Pediatrics (Licence: WV 19872) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2024-05-01 |