| NPI | 1053501809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX M7387) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 254454) |
| 207P00000X Emergency Medicine (Licence: TX m7387) | |
| 208600000X Surgery (Licence: TX M7387) | |
| 208600000X Surgery (Licence: TX M7383) | |
| 208600000X Surgery (Licence: NY 254454) | |
| 208D00000X General Practice (Licence: NY 254454) | |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2024-03-01 |