| NPI | 1669667952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N3879) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N3879) |
| 207Q00000X Family Medicine (Licence: NM MD2008-0829) | |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2019-12-18 |