| NPI | 1912165184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P0633) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX P0633) |
| 207Q00000X Family Medicine (Licence: WI 5496820) | |
| Enumeration Date | 2008-05-23 |
| Last Update Date | 2023-01-05 |