| NPI | 1407140106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX BP10041308) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 206929) |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2017-01-09 |