| NPI | 1083920813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R1862) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 47947) |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2026-03-09 |