| NPI | 1912633587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX W1731) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 11023848A) |
| Enumeration Date | 2022-07-26 |
| Last Update Date | 2026-02-10 |