| NPI | 1184104218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T4367) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS16258) |
| 207Q00000X Family Medicine (Licence: WA OP61305097) | |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2026-04-21 |