| NPI | 1811982754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2018021841) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX K9279) |
| 207Q00000X Family Medicine (Licence: TX K9279) | |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2018-11-29 |