| NPI | 1790730133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q6828) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A87811) |
| 207P00000X Emergency Medicine (Licence: TX Q6828) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2026-03-16 |