| NPI | 1861423667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX H8372) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX H8372) |
| 207P00000X Emergency Medicine (Licence: TX H8372) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2016-02-23 |