| NPI | 1255958484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-16693) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX V3458) |
| 207P00000X Emergency Medicine (Licence: AR E-16693) | |
| Enumeration Date | 2020-07-03 |
| Last Update Date | 2025-10-05 |