| NPI | 1578676086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P4773) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA L12247R) |
| 207Q00000X Family Medicine (Licence: LA L12247R) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2025-04-10 |