| NPI | 1083149322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T7241) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX T7241) |
| 207Q00000X Family Medicine (Licence: AL MD.38519) | |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2023-08-03 |