| NPI | 1740574144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P3896) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: TX P3896) |
| 207Q00000X Family Medicine (Licence: CO DR.0056087) | |
| 207Q00000X Family Medicine (Licence: TX 503OL33918961) | |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2020-12-01 |