| NPI | 1982067658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: TX T6531) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101262953) |
| 207Q00000X Family Medicine (Licence: TX T6531) | |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2023-04-12 |