| NPI | 1881855039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P3462) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101251832) |
| 208000000X Pediatrics (Licence: VA 0101251832) | |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2015-10-08 |