| NPI | 1679561880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX F7376) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX F7376) |
| 207Q00000X Family Medicine (Licence: TX F7376) | |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2021-03-22 |