| NPI | 1679942841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 287300) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P2910) |
| 207P00000X Emergency Medicine (Licence: TX P2910) | |
| Enumeration Date | 2015-09-17 |
| Last Update Date | 2026-06-24 |