| NPI | 1407319189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX W2935) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL MD42331) |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2026-02-24 |