| NPI | 1689966780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N9480) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: TX N9480) |
| Enumeration Date | 2011-05-07 |
| Last Update Date | 2017-01-31 |