| NPI | 1003102245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P6209) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: TX P6209) |
| 207P00000X Emergency Medicine (Licence: TX P6209) | |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2015-06-30 |