| NPI | 1063487023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX F0348) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX F0348) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TX F0348) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2009-05-19 |