| NPI | 1619961315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 7654201-1204) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 7654201-1204) |
| 207Q00000X Family Medicine (Licence: WI 46160-021) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2017-06-30 |