| NPI | 1326059155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 187150-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 1871501205) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2017-03-31 |