| NPI | 1285823641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX BP20024815) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX n1064) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2013-12-04 |