| NPI | 1730573254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S3661) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S3661) |
| 207Q00000X Family Medicine (Licence: IN 11018498A) | |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2025-10-02 |