| NPI | 1013439504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX PA16706) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA16706) |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2024-08-09 |