| NPI | 1063707248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301098883) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX Q0951) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2015-06-10 |