| NPI | 1114330941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R5413) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 2914331) |
| 207P00000X Emergency Medicine (Licence: NY 2914331) | |
| 207Q00000X Family Medicine (Licence: TX R5413) | |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2022-01-25 |