| NPI | 1639508542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NV 17348) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S2703) |
| 207Q00000X Family Medicine (Licence: NV 17348) | |
| 207Q00000X Family Medicine (Licence: TX BP10049157) | |
| Enumeration Date | 2013-11-01 |
| Last Update Date | 2021-06-23 |