| NPI | 1861704744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX G0199) |
| Additional Taxonomies | 202C00000X Independent Medical Examiner (Licence: TX GO199) |
| 207P00000X Emergency Medicine (Licence: TX G0199) | |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2018-06-16 |