| NPI | 1033779772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX V6645) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD477779) |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2025-06-03 |