| NPI | 1073747275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P4375) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 146D00000X Personal Emergency Response Attendant (Licence: TX P4375) | |
| 261QP2300X Clinic/Center, Primary Care (Licence: TX P4375) | |
| Enumeration Date | 2009-05-04 |
| Last Update Date | 2014-07-08 |