| NPI | 1538157979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX D4374) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX D4374) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2011-05-13 |