| NPI | 1992297642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T0846) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: TX T0846) |
| 207Q00000X Family Medicine (Licence: MI 4301114775) | |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2026-07-14 |