| NPI | 1891112140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T1624) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 294810) |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2025-08-26 |