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 |