| NPI | 1821112616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R6732) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R6732) |
| 207RN0300X Internal Medicine, Nephrology (Licence: CO DR.0056152) | |
| 225100000X Physical Therapist (Licence: TX 1168543) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-03-18 |
| Last Update Date | 2024-11-19 |