| NPI | 1104262625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-9059) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AR E-9059) |
| 207P00000X Emergency Medicine (Licence: TX Q9741) | |
| 207Q00000X Family Medicine (Licence: TX Q9741) | |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2023-07-31 |