| NPI | 1528265774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N8366) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX N8366) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2012-01-13 |