| NPI | 1891856902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301044889) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX G0023) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2014-12-10 |