| NPI | 1023121613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX J3408) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX J3408) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TX J3408) | |
| 207Q00000X Family Medicine (Licence: PR 007936) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2022-01-28 |