| NPI | 1619148715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N1418) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX N1418) |
| 207Q00000X Family Medicine (Licence: WA MD00049216) | |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2022-12-07 |