| NPI | 1770894024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX s3991) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: TX s3991) |
| 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: PA MD449837) | |
| 208M00000X Hospitalist (Licence: PA MD449837) | |
| 207Q00000X Family Medicine (Licence: PA MD449837) | |
| 207R00000X Internal Medicine (Licence: TX S3991) | |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2025-09-17 |