| NPI | 1013353747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX Q1186) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX Q1186) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10047767) | |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2026-08-13 |