| NPI | 1063492254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX H4928) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX H4928) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2007-07-23 |