| NPI | 1831509405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R6743) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX R6743) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2020-10-23 |