| NPI | 1457316614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K7387) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A64214) |
| 207Q00000X Family Medicine (Licence: CA A64214) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2009-05-27 |