| NPI | 1013103209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX S8077) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX S8077) |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2023-03-07 |