| NPI | 1245644673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX Q6143) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q6143) |
| 207P00000X Emergency Medicine (Licence: TX Q6143) | |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2025-10-06 |