| NPI | 1629566906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U5830) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX U5830) |
| 207R00000X Internal Medicine (Licence: GA 84432) | |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2023-10-17 |