| NPI | 1225491046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S0160) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX S0160) |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2019-07-12 |