| NPI | 1104015577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N0730) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N0730) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2017-01-23 |