| NPI | 1053323261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M8406) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 0-31092) |
| 207P00000X Emergency Medicine (Licence: TX M8406) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2022-07-21 |