| NPI | 1689086928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX BP10050110) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX Q7584) |
| Enumeration Date | 2014-05-21 |
| Last Update Date | 2023-12-21 |