| NPI | 1053730010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX F4604) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX F4604) |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2020-09-06 |