| NPI | 1013470939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX AP142424) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: TX 849764) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2020-04-27 |