| NPI | 1508067885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N1092) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: TX N1092) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX N1092) | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2017-02-15 |