| NPI | 1730479981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P7324) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX 550535) |
| 207Q00000X Family Medicine (Licence: TX P7324) | |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2023-03-07 |