| NPI | 1245597483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R1423) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 053966) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2026-03-10 |