| NPI | 1245610344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S3795) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX S3795) |
| 207P00000X Emergency Medicine (Licence: CA 20A15415) | |
| 207Q00000X Family Medicine (Licence: CA xxxxxxxxxx) | |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2020-03-23 |