| NPI | 1952045254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX VB244) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A208253) |
| 207R00000X Internal Medicine (Licence: CA A208253) | |
| 208000000X Pediatrics (Licence: TX V8244) | |
| Enumeration Date | 2022-04-22 |
| Last Update Date | 2026-07-06 |