| NPI | 1306891726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: TX R1312) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301065653) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2021-03-24 |