| NPI | 1003977323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N5677) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00042086) |
| 207P00000X Emergency Medicine (Licence: TX N5677) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2014-03-10 |