| NPI | 1114195724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P0454) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX P0454) |
| 207Q00000X Family Medicine (Licence: LA 202973) | |
| Enumeration Date | 2008-02-16 |
| Last Update Date | 2024-06-11 |