| NPI | 1982904033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N7050) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX n7050) |
| 208D00000X General Practice (Licence: TX n7050) | |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2023-08-22 |