| NPI | 1629057260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX L8790) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 3671) |
| 207P00000X Emergency Medicine (Licence: TX L8790) | |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2016-04-18 |