| NPI | 1780680439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX F3971) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX F3971) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2011-08-04 |