| NPI | 1093447310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX V8046) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2025-0643) |
| Enumeration Date | 2022-06-27 |
| Last Update Date | 2025-11-12 |