| NPI | 1174566525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX H6552) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX H6552) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2013-03-22 |