| NPI | 1952321820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD.022539) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA MD-50315) |
| 207R00000X Internal Medicine (Licence: TX U6847) | |
| 208000000X Pediatrics (Licence: LA MD.022539) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2024-09-09 |