| NPI | 1841476694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N1083) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX N1083) |
| 207P00000X Emergency Medicine (Licence: TX N1083) | |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2021-12-01 |