| NPI | 1275025371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T1715) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX t1715) |
| 207Q00000X Family Medicine (Licence: GA 84769) | |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2022-07-08 |