| NPI | 1598969164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M8014) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10026813) |
| 207P00000X Emergency Medicine (Licence: TX M8014) | |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2015-01-12 |