| NPI | 1033191424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX L1756) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX L1756) |
| Enumeration Date | 2005-11-19 |
| Last Update Date | 2010-06-28 |