| NPI | 1396799771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD10662R) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M2421) |
| 207P00000X Emergency Medicine (Licence: LA MD.10662R) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2009-01-15 |