| NPI | 1366853210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q7103) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX 7103) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2021-07-09 |