| NPI | 1013917988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX G5303) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX G5303) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2016-08-24 |