| NPI | 1063829075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T9222) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A146481) |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2025-12-18 |