| NPI | 1972752954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N4658) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX N4658) |
| 207Q00000X Family Medicine (Licence: TX BP10032214) | |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2025-07-18 |