| NPI | 1568758670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101256596) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX P4237) |
| 207Q00000X Family Medicine (Licence: TX P4237) | |
| 207Q00000X Family Medicine (Licence: TX BP10039976) | |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2022-11-11 |