| NPI | 1407979255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N0220) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX N0220) |
| 207Q00000X Family Medicine (Licence: NM MD2007-0124) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2019-02-07 |