| NPI | 1275506206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K7946) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: TX K7946) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2023-08-25 |