| NPI | 1013900497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX E6365) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX E6365) |
| 207PE0004X Emergency Medicine Emergency Medical Services (Licence: TX E6365) | |
| 207VG0400X Obstetrics & Gynecology Gynecology (Licence: TX E6365) | |
| 207VX0000X Obstetrics & Gynecology Obstetrics (Licence: TX E6365) | |
| 208000000X Pediatrics (Licence: TX E6365) | |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2007-07-12 |