| NPI | 1710181664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N1974) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01063779A) |
| 207P00000X Emergency Medicine (Licence: TX N1974) | |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2009-04-29 |