| NPI | 1700911070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U8523) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA G80912) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2025-07-09 |