| NPI | 1164607446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P3527) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SD 7526) |
| 207Q00000X Family Medicine (Licence: IN 01068417A) | |
| Enumeration Date | 2008-01-04 |
| Last Update Date | 2020-06-16 |