| NPI | 1003889478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q6080) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 45595) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2023-01-27 |