| NPI | 1013413335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX V3878) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 32106) |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2024-11-21 |