| NPI | 1891762753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N4712) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 36040) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2023-02-21 |