| NPI | 1922444280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T0989) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 204536) |
| 207R00000X Internal Medicine (Licence: DC MD600004839) | |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2025-09-03 |