| NPI | 1285642603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX E-2504) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX E2504) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TX E2504) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2015-06-30 |