| NPI | 1902032162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N7666) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10035372) |
| 207Q00000X Family Medicine (Licence: TX N7666) | |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2015-10-31 |