| NPI | 1629073648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K7753) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX K7753) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2014-01-23 |