| NPI | 1972591782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL MD.35626) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN md21385) |
| 207R00000X Internal Medicine (Licence: TX N4758) | |
| 208000000X Pediatrics (Licence: TN 21385) | |
| 208000000X Pediatrics (Licence: TX N4758) | |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2023-01-19 |