| NPI | 1962728451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q0937) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX Q0937) |
| Enumeration Date | 2010-04-09 |
| Last Update Date | 2021-08-19 |