| NPI | 1851896807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T3291) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX T3291) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2023-03-24 |