| NPI | 1134106743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E6191) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AR E6191) |
| 207Q00000X Family Medicine (Licence: TX M1800) | |
| 207Q00000X Family Medicine (Licence: MD D61970) | |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2025-02-24 |