| NPI | 1194784728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N4468) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N4468) |
| 207R00000X Internal Medicine (Licence: NC 9500093) | |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2024-04-29 |