| NPI | 1669868568 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R4174) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10052475) | 
| Enumeration Date | 2015-04-08 | 
| Last Update Date | 2025-07-27 |