| NPI | 1811934821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M5954) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2004-0663) |
| 207P00000X Emergency Medicine (Licence: TX M5954) | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2020-08-13 |