| NPI | 1669412243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX J8496) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX J8496) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: TX J8496) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2015-02-13 |