| NPI | 1811315369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T1837) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX T1837) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX T1837) | |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2025-05-23 |