| NPI | 1740412840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P5019) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX P5019) |
| 207Q00000X Family Medicine (Licence: NM MD2016-0867) | |
| Enumeration Date | 2009-08-23 |
| Last Update Date | 2023-10-27 |