| NPI | 1831189836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX L2554) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX L2554) |
| 207Q00000X Family Medicine (Licence: LA MD.024374) | |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2016-06-15 |