| NPI | 1205455581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX W4413) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME165691) |
| 208D00000X General Practice (Licence: TX W4413) | |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2026-04-06 |