| NPI | 1023122371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX K7235) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX K7235) |
| 208D00000X General Practice (Licence: TX K7235) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2019-09-19 |