| NPI | 1336336205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX S3534) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 29905) |
| 207P00000X Emergency Medicine (Licence: KY 45542) | |
| 207Q00000X Family Medicine (Licence: MO 2009026103) | |
| 207Q00000X Family Medicine (Licence: TX BP10030099) | |
| 207Q00000X Family Medicine (Licence: KY 45542) | |
| 207Q00000X Family Medicine (Licence: OK 29905) | |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2021-07-19 |