| NPI | 1598761207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M3566) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 12239R) |
| 207P00000X Emergency Medicine (Licence: TX M3566) | |
| 207P00000X Emergency Medicine (Licence: LA MD.12239R) | |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2026-09-15 |