| NPI | 1306154703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T9711) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T9711) |
| 207Q00000X Family Medicine (Licence: NM A-1982-16) | |
| 207Q00000X Family Medicine (Licence: NY 267245) | |
| Enumeration Date | 2010-09-20 |
| Last Update Date | 2025-10-01 |