| NPI | 1932101268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX K7167) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX K7167) |
| 208000000X Pediatrics (Licence: TX K7167) | |
| 207P00000X Emergency Medicine (Licence: TX K7167) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2022-01-20 |